Wake County Human Services Board Minutes September 27, 2012

Members Present: Executive Staff: Guests: Dr. Dianne Dunning, Chair Mr. Ramon Rojano, Human Services Director Bd. Candidates for Interviews Mr. Pablo Escobar, Vice Chair Mr. Joseph Threadcraft, Environmental Services Director Mr. Frank Eagles Mr. Paul Gross, HS Finance Officer Dr. Sharon Foster Ms. Jonica Hinton, Executive Assistant Ms. Leila Goodwin Ms. Sue Lynn Ledford, Public Health Administrator Quorum Present: yes Dr. Paul Norman Dr. Peter Morris, Medical Director Ms. Margaret Raynor Ms. Katherine Williams, Human Capital Development Mr. Julian Smith Commissioner James West Staff Absent: Mr. Joe Durham, Deputy County Manager Members Absent: Mr. Scott Warren, County Attorney Dr. Burton Horwitz Ms. Rebecca Linthicum, County Budget Office Mr. Benny Ridout Mr. Bob Sorrels, HS Deputy Director Dr. Osama Said Ms. Regina Petteway, Office of Community Affairs

Presenters: Ms. Denise Foreman, Assistant to the County Manager Mr. Brian Gunter, Human Rights/Consumer Affairs

Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Due Party Date I. Call to Order Vice Chair Pablo Escobar called the meeting to order @ 7:34 a.m. and led the N/A Board in a moment of silence.

II. Approval of Minutes Mr. Frank Eagles motioned, seconded by Dr. Paul Norman, to approve the N/A August 23, 2012, Board meeting minutes. Motion passed unanimously.

III. Confirmation of Next The next Board meeting is scheduled for October 25, 2012, 220 Swinburne N/A Board Meeting Street, 2nd Fl., Rm. 2132, 7:30 a.m. – 10 a.m.

No. 248 Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Due Party Date IV. Oath of Office Commissioner James West administered the oath of office to the following N/A Board members: 1. Dr. Sharon Foster (Other Physician) - Reappointment Term: November 15, 2011 –November 14, 2015. 2. Ms. Margaret Raynor (Registered Nurse) - New Appointment to fill Unexpired Term: September 4, 2012 – November 14, 2014. CONSENT AGENDA V. Consent Agenda: Human Rights/Consumer Affairs Committee – Mr. Pablo Escobar, Chair Approved Studies. Approval of Studies Upon request of Vice Chair Pablo Escobar, Mr. Brian Gunter gave an Request for summary overview of the Research Studies. of results and outcomes is 1. Optimizing Outcomes with Women with Gestational Diabetes Mellitus and incorporated in the Their Infants. The purpose of the research is to improve health outcomes agreement/approval for at-risk women with Gestational Diabetes Mellitus and their infants. form. Dr. Sharon Foster motioned, seconded by Mr. Frank Eagles, to approve the Study: Optimizing Outcomes with Women with Gestational Diabetes HRC Committee has Mellitus and Their Infants. Motion passed unanimously. requested a summary of studies from the last two years. The 2. Prospective Comparison of TB Skin Test to Interferon-Gamma Release HRC Committee is Assays in Diagnosing Infection with Mycobacterium TB and in Predicting considering Progression to TB. The study involves persons tested for latent TB developing a regular infection who are at high risk of exposure or high risk of progression to TB quarterly agenda to disease. The study assesses the relative performance and costs of three report study activities diagnostic tests for latent TB. and results. Dr. Sharon Foster motioned, seconded by Mr. Frank Eagles, to approve the Study: Prospective Comparison of TB Skin Test to Interferon-Gamma Note: some studies Release Assays in Diagnosing Infection with Mycobacterium TB and in are multi-staged and Predicting Progression to TB. Motion passed unanimously. WCHS may or may not be part of the next 3. Randomized Trial to Prevent Congenital Cytomegalovirus Infection. This stage. study will screen pregnant women for Congenital Cytomegalovirus Infection and seek to determine if treatment helps the baby. Risk involved is no more than minimal. Dr. Sharon Foster motioned, seconded by Mr. Frank Eagles, to approve the Randomized Trial to Prevent Congenital Cytomegalovirus Infection. Motion passed unanimously.

No. 249 Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Due Party Date REGULAR AGENDA VI. Board Member The Board has been conducting interviews for vacant Board positions at the Approved Board Nomination Executive Committee meetings and at the regular Board meetings. All Board Member Nomination Recommendations members are urged to participate at the Executive Committee meetings. Recommendations.

Executive Committee Vice Chair Pablo Escobar presented the Executive Committee’s nominations Recommendations for Board member recommendations as follows: will be forwarded to Vice Chair Pablo county commissioners Escobar 1. Tameko H. Piggee (Social Worker) – Term: November 15, 2012 – for consideration of November 14, 2016. official appointments.

2. James A. Smith, III, MD, DLFAPA (Psychiatrist) – Unexpired Term: October 2, 2012 – November 14, 2015.

Upon recommendation by the Executive Committee, seconded by Mr. Julian Smith, the Board approved recommendations of (1) Ms. Tameko H. Piggee and (2) Dr. James A. Smith. Motion passed unanimously. The recommendations will be forwarded to the county commissioners for consideration of official appointments.

VII. 2013 Board Officers The Nomination Procedures and Form for 2013 Board Officers were emailed to Nominations for 2013 Nomination Form, all Board members mid-September. Copies were also distributed today. Vice Board Officers are Process, Due Date Chair Escobar reminded Board members that nominations are due by Noon, due by October 12, October 12. Also, please get permission/willingness from the person you 2012. Executive Committee nominate. 2013 Elections will be conducted at the October Board meeting. Vice Chair Pablo Escobar

No. 250 Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Due Party Date VIII.Board Interviews The Board interviewed the following candidates. Recommended Mr. Mckinley Wooten, Jr. 8:00 am Mckinley Wooten, Jr., Consumer of HS Category for the Consumer of 8:30 am Myra Brickell, Pharmacist Category HS Board Position. The recommendation Handouts: will be forwarded to  Applications county commissioners for consideration of  Rubric and Interview Questions official appointment.  Current Board Diversity Profile and Board Member Terms The Board is Vice Chair Escobar led the interview process, and Board members participated conducting interviews in the interview questions. twice a month: at the Executive Committee Ms. Leila Goodwin motioned, seconded by Dr. Dianne Dunning, to meetings and at the recommend Mr. Mckinley Wooten, Jr. for the Consumer of Human Services regular Board position. Motion passed unanimously. The recommendation will be forwarded meetings. All Board to the county commissioners for consideration of official appointment. members are urged to participate. The Board recommended to keep the Pharmacist position open a while longer in order to give other strong candidates an opportunity to apply. Chair Dunning also suggested contacting Commissioner Tony Gurley, who is also a pharmacist, for possible candidates.

No. 251 Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Due Party Date IX. Update on Board Update on Board Member Recruitment Plan: Ongoing interview Member Recruitment process. Plan  Based on feedback by several Board members who believed some of the interview questions were redundant and/or difficult, Vice Chair Pablo Escobar agreed to draft revised questions. Overall, the Board believed the interview process was working well. Many liked the structured process.  Several Board members asked about the status of Dr. Osama Said who serves in the Optometrist Board position. Mr. Rojano said that Dr. Said has had some personal issues that have hindered his attendance. There may be a need to look for potential candidates in this category.  Ms. Leila Goodwin suggested that a letter be mailed to the other Social Worker candidates interviewed to let them know that a selection has been made in that category and that there is still opportunity for further consideration in the general public category.

Mr. Ramon Rojano gave the following update:  The Board has reserved recommendations of the two general public positions for last. Mr. Rojano reported that there are applications. Mr. Rojano and Ms. Regina Petteway are screening applications and will submit the top five candidates to the Board Recruitment Group for further review and screening.  Ms. Petteway received a name of a Veterinarian candidate from the community network. Staff is following up with him.  Mr. Rojano has contacted Ms. Sally Cameron, Wake County Psychological Association, for psychologist recommendations.  Still working on a candidate for the Dentist position.

No. 252 Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Due Party Date X. Update on Falls Lake Mr. Joseph Threadcraft, Environmental Services Director, introduced Ms. Received an update Nutrient Management Melinda Clark, Environmental Services Watershed Programs Manager, who on the Falls Lake Strategy gave an overview on the Falls Lake Rules: Implementation of Stage I Rules Rules: and Reexamination of Stage II Rules. Highlights: Implementation of Mr. Joseph State I Rules and Threadcraft,  Falls Lake is currently classified by the North Carolina Environmental Management Reexamination of Environmental Commission (EMC) as WS-IV, B: NSW, CA. Pursuant to this classification, the Stage II Rules. Services Director designated uses of Falls Lake include aquatic life propagation and biological integrity (including fishing and fish), wildlife, primary and secondary recreation, Keep the Board Ms. Melinda Clark, agriculture, and water supply. Falls Lake serves as a water supply for the City of informed to the extent Watershed Programs Raleigh (Raleigh) and six other municipalities in Wake County. of a public health risk Manager  In 2008, the N.C. Division of Water Quality (DWQ) listed the Lake as impaired for and to have Board biological integrity due to exceedances of the State chlorophyll-a water quality support. standards in the upper portion of the Lake.  The NC Environmental Management Commission (EMC) passed in 2010, the Fall Lake Rules requiring two stages of nutrient reductions to reduce eutrophication in the Lake and to bring the waterbody into compliance with the chlorophyll-a standard. Stage 1, to be implemented by 2016, is designed to achieve compliance in the Lower Lake (below Highway 50) and to improve water quality in the Upper Lake (above Highway 50) and Stage 2, to be implemented by 2025, is designed to further address water quality in the Upper Lake.  The Stage 1 management measures include reductions from all major categories of nutrient sources including point sources, agriculture, new development and existing development. Wake County must implement nutrient reductions rules for new and existing development.  The EMC acknowledged uncertainty associated with the models used to develop the required nutrient load reductions and allowed for reexamination of the Rules. This reexamination would involve additional monitoring and modeling to form a scientific basis for modifying the required load allocations.  In response to the Rules, local governments in the watershed developed a set of Consensus Principles to help shape the reexamination of the Stage II Rules. The group agreed rules are needed to protect Falls Lake as a water supply.  The Upper Neuse River Basin Association (UNRBA) representing 14 local governments has taken the lead in the reexamination of Stage II Rules and has hired a consultant, Cardno-Entrix to determine the best approach to address the nutrient management rule requirements.  Wake County Commissioner, Ervin Portman, is a member of the UNRBA Board of Directors and Melinda Clark, Watershed Programs Manager for Environmental Services, serves as the County’s alternate on the Board. Staff participates in numerous subcommittees facilitating the reexamination of the Rules.  The Environmental Services Department will inform the Human Services Board of UNRBA’s proposals to address the rules and opportunities for the HSB to advocate

No. 253 Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Due Party Date XI. Update on Wake Ms. Denise Foreman gave an update on the Wake County Behavioral Health County Behavioral Services and how the county will maximize partnership opportunities. Health Services Highlights:

Ms. Denise Foreman,  Wake County partnered with UNC Health Care and the State of North Assistant to the Carolina last fall to hire a consultant to study current services, community County Manager gaps, and options in behavioral health services and the use of Wake County funds.  Alliance Behavioral Healthcare has received news that it is progressing through the Mercer Review.  Wake has been working with UNC and ABH since May on how to work through the conflicts of interest with Wake County Behavioral Health Services. There is still much work to do.  Have a fairly detailed plan for the approach for the WakeBrook Campus. Looking at continued Crisis and Assessment Services, 16 beds for detox and 16 beds for rehab (both dually licensed facilities for substance abuse and mental health services). The vacant 16 beds would be for high acuity inpatient services not being addressed by other resources across the state. The partners are at the table to figure out how the local, state, and federal dollars and UNC resources would come together to make it work.  Crisis and Assessment Services is allowed to keep patients up to 23 hours. However, they have been forced on a regular basis to keep patients longer because the services at the next level of care are not always available.  This will not address everything needed in the community; however, the partners believe this will be an improvement in access and higher level of care for patients. Wake will still need to continue its work with the state to address some of the existing gaps.  The other parts consist of outpatient services (an array of services for children, adults, MH/DD/SA) that Wake County Behavioral Health Services has been providing. This consists of $28 million between all revenue sources.  UNC and ABH have been trying to understand the way Wake has been providing these services in order to help Wake figure out the best way to move these services forward.

(Cont.)

No. 254 Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Due Party Date XI. Update on Wake  The partners will meet today at 10:00 a.m. to decide what the plan will be County Behavioral and what will inform the decisions. The partners know that Wake County Health Services staff will not provide the services because of the conflicts of interest. (Cont.) However, there is work to figure out what the services will be, who will provide the services, and at what costs. The partners do not yet have a clear Ms. Denise Foreman, map of the steps along the way. Assistant to the County Manager  Plans are to share the picture of the process and timeline with the stakeholders group on October 5.  UNC Public Health School students are researching some best practices and national models for how some of these services might be provided in the future.  The stakeholders group comprises Wake County staff, UNC Health Care staff, Alliance Behavioral Healthcare staff, consumers, advocates, providers, all of the local hospitals, Holly Hill Hospital, Strategic Behavioral, NAMI and CFAC (about 40 stakeholders).  Have not defined guiding principles yet. Partners are looking for an appropriate balance between the services that are offered and the funding that is available. There will continue to be unmet needs. The state is reducing its funding, and Medicaid will be a challenge to manage. The county dollars are used to fill the gaps.  There are 220 Wake County staff affected by these changes. Wake County management has met with staff once and has sent a memo about a month ago. Management committed to come back to staff when they could answer relevant questions. Anticipate meeting with staff the week of October 8.  Ms. Margaret Raynor asked what type of coordination is being done for patients with other health needs, such as co-morbidities and integration of primary care. Ms. Foreman said she would follow up with Alliance Behavioral Healthcare. Mr. Rojano said the LME plans included coordination with Community Care of North Carolina. However, there has been tremendous work to convert LMEs into MCOs.  Wake County will not be able to divest of services by January 1, 2013, to address the conflict of interest issues; therefore, Wake is talking with the state about a temporary extension.

No. 255 Agenda Item Discussion, Conclusions, Recommendations Action, Follow-up Responsible Due Party Date DIRECTORS’ REPORTS

XII. Human Services and Environmental Services – Mr. Joseph Threadcraft, Director Environmental Services Directors’  Dr. Jyothi V. Robertson, DVM, President of JVR Shelter Strategies and also Reports a U.C. Davis Associate Professor, will arrive September 30, 2012, to start Phase-I of the Wake County Animal Services Shelter Assessment. We are scheduled to meet with Dr. Dunning at the NC State College of Veterinary Medicine on October 2, 2012. In addition to providing operational guidelines, this assessment will serve as the basis of our Memorandum of Agreement to form a mutually beneficial relationship between Wake County and NC State College of Veterinary Medicine.

Human Services – Mr. Ramon Rojano, Director  The September Issue of WCHS Headlines was distributed.  WCHS Data Report Final Q4 FY12 (handout).  WCHS Budget Update (handout).  Deferred updates on NC Fast / Document Imaging and Oral Health/Dental Card Program.

CHAIR’S REPORT

XIII. Board Chair’s Chair Dunning informed the Board that she was contacted by The Report Independence newspaper regarding some changes in child welfare policy related to IV-E Funding reductions and how the agency applies those funding for services.

XIV. Adjournment With no other business, the Board meeting was adjourned at 10:06 a.m.

Board Chair Approval Pablo J. Escobar, Board Vice Chair

Dianne Dunning, Chair, DVM, MS, DrPH, DACVS

No. 256 No. 257